Provider Demographics
NPI:1073508768
Name:GARDEN VIEW CARE CENTER, INC.
Entity Type:Organization
Organization Name:GARDEN VIEW CARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:A
Authorized Official - Last Name:LITLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-240-2840
Mailing Address - Street 1:700 GARDEN PATH
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-3052
Mailing Address - Country:US
Mailing Address - Phone:636-240-2840
Mailing Address - Fax:636-978-0738
Practice Address - Street 1:700 GARDEN PATH
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-3052
Practice Address - Country:US
Practice Address - Phone:636-240-2840
Practice Address - Fax:636-978-0738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-19
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO029569314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO102476702Medicaid
MO102476702Medicaid